改良运动计划单独使用或与脊柱健康教育联合使用对慢性下腰痛的效果如何？一项随机对照临床试验。

How effective is a modified exercise program on its own or with back school in chronic low back pain? A randomized-controlled clinical trial.

作者信息

Durmus Dilek, Unal Mustafa, Kuru Omer

机构信息

Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.

Department of Family Medicine, Ondokuz Mayis University, Samsun, Turkey.

出版信息

J Back Musculoskelet Rehabil. 2014;27(4):553-61. doi: 10.3233/BMR-140481.

DOI:10.3233/BMR-140481

PMID:24867906

Abstract

BACKGROUND AND OBJECTIVES

The aim of this trial is to search effectiveness of specifically adapted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP).

MATERIAL AND METHOD

A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n=60) was given exercises only and accepted as the control group. Group 2 (n=61) received back school program and exercises. The exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F).

RESULTS

Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT-BT test and F-BT test (P < 0.05). Group 2 improved more than group 1 except for mobility.

CONCLUSION

Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further.

LEVEL OF EVIDENCE

Diagnostic study Level-I-I (prospective study).

摘要

背景与目的

本试验旨在探究专门设计的运动方案单独使用以及与腰痛学校相结合，对慢性腰痛（CLBP）患者的疼痛、功能障碍、躯干和股四头肌力量、步行能力、脊柱活动度、生活质量（QOL）及抑郁状况的效果。

材料与方法

本研究共纳入121例确诊为CLBP的患者。患者被随机分为两组。第1组（n = 60）仅进行运动，作为对照组。第2组（n = 61）接受腰痛学校课程及运动。运动治疗每周进行3天，共3个月。评估所有参与者的疼痛（视觉模拟量表，VAS）、功能障碍（奥斯维斯特功能障碍问卷，ODQ）、步行能力（6分钟步行试验，6MWT）、抑郁（贝克抑郁量表评分，BDI）及QOL（简明健康状况调查量表，SF - 36）。使用手持测力计测量躯干和膝部肌肉力量。在基线（BT）、治疗结束时（AT）及6个月随访时（F）对患者进行评估。

结果

随着时间推移，两组在所有临床参数方面均有统计学显著改善。两组的疼痛、功能障碍、肌肉力量、耐力、6MWT、活动度、QOL及抑郁在AT时也均有改善。这些改善在6个月随访时持续存在（P < 0.05）。在AT - BT测试与F - BT测试的变化分数方面，两组在疼痛、功能障碍、肌肉力量、耐力、6MWT、QOL及抑郁方面存在统计学显著差异（P < 0.05）。除活动度外，第2组的改善程度大于第1组。